Sounds like you are persistent AFIB Smackman, and the only difference with the definition of 'long-term persistent is just that, that the duration of persistent AFIB is very long term, over a year plus without stop or conversion.
Permanent AFIB is the final classification and usually is reserved for 24/7 persistent AFIB that fails all attempts at cardioversion and the patient and Cardiologist/EP agree to stop trying to convert to NSR and instead focus only on rate control and anti-coagulation.
You are not there yet and in around two weeks will make a major step with your index ablation with Dr. Natale toward regaining far more NSR back in your life than you have imagined was possible.
Long term persistent isn't really an 'official' distinction, but rather is a functional description of someone with longer term persistent which tends to imply a much greater likelihood of more structural remodeling and fibrosis having occurred than for those who are still paroxysmal or in the first 3 to 6 months of persistent AFIB before they come for Ablation.
While you have been diagnosed with persistent AFIB for nearly two years ( if I understand you correctly?) you have also spent a fair amount of that time in NSR or mixed NSR with AFIB or flutter periods in between cardioversions. As such you can subtract that NSR time from your total. In fact, its more than just a linear subtraction of the months in NSR because the longer you are in NSR the more reverse remodeling has taken place and thus you are also restoring some of the more resilient substrate to some degree and certainly a good deal of electrical remodeling, so even if you had two total years since you went into persistent AFIB, is that period has been broken up by several periods of a number of months of NSR that is a much better scenario compared to 2 unbroken consecutive years of full blown 24/7 persistent AFIB.
The rule of thumb that Professors Haissaguerre and Jais noted at the Boston AFIB Symposium 2014 last month in Orlando, derived from their vast experience and research in this area, is that the optimal window to get an index persistent AFIB ablation .. assuming you didn't go for a first ablation much earlier when one was still in early paroxysmal days, which is obviously a far better starting point, is to get that first index persistent AFIB ablation within 6 months of the onset of persistent AFIB, in which case the odds of good longer term success are in the roughly 75% to 80% tops range for a single ablation to still have NSR one year later.
Once you have a solid year of unbroken persistent AFIB prior to the index persistent AF ablation, the odds that a single ablation will give you unbroken NSR for at least 1 full year drops quite a bit to around 54% top 57% based on the step-wise segmental based PVI ablation with added linear lines and CAFE ablations where needed. Once the person procrastinates for 2 full consecutive years of unbroken AFIB, their odds for a single ablation to do the trick drop further and by year 4 of unbroken persistent AFIB the odds of a single ablation using the Bordeaux method have dropped to the mid 20% range.
Hence the wisdom not to hem and haw too long once things turn 24/7 persistent AFIB.
Keep in mind that with Natale's very progressive persistent AFIB ablation approach, which in recent years has added in the full isolation of both the LAA and CS ( coronary sinus) when required and which has greatly increased the early success in these cases, in addition to added work along the intra-atrial septum, the anterior wall and addressing any active CAFE's his mapping deem to be likely contributors to your arrhythmia, his odds seem somewhat better now with a large group of persistent cases needing on average roughly around 1.4 ablations to get the job very satisfactorily done.
Both Bordeaux and Natale's group represent the cutting edge in this field and both achieve closely comparable results overall. Bordeaux has now added int the Cardio-insight non-invasive phase-mapping system to their equation which they hope will further improve long term results, or at perhaps at least shorten their procedure time needed to achieve comparable results to their step-wise technique, but its still much too early to determine just what the long term results will be.
Similarly, Dr Natale has pioneered a number of techniques and has even more experience now with the LAA/CS isolation protocol in more advanced cases where driving triggers are found in those two areas during challenge mapping, than does the Bordeaux group with this very new Cardio-insight vest and rotor mapping. I know that Natale is more convinced than ever from all of his experience going back five years now at doing these LAA isolations, and from all the data his groups have collected that this is a key step for much better long term results with persistent cases in particular.
Perhaps in the next couple years it will be shown that both aspects of Natale;s and Bordeauxs new contributions will be mutually additive toward even better and faster results in the long term. Time will tell, but right now you can rest assured that you have as fine a pair of hands and mind that you can find anywhere on planet earth who is fixing to take charge of your case! As such, you can relax and truly let go and accept however it plays out.
By far you best mental approach is the fully expect a two procedure process in order to get you really over the hump for the long term, and then if you wind up being 'one and done', which is a distinct possibility with the EP you have chosen, then consider it a real gem of a bonus. That is the best way to go into this thing with a solid and strong demeanor and accurate viewpoint.
If you do just make big progress on this first ablation as the major work is accomplished, but there remains a few small areas that need a touch up at some point down the line to button everything do for good, so be it and be very happy you have gotten over the major step of this first procedure and remember that even if another touch up is needed it will almost invariably be far easier than the first, mostly psychologically easier as you will know what to expect and will no longer be tormented by all the 'what if' and oh may god what have I gotten myself into' kind of mental gymnastics that are so common in the last week to two before the first one. And truly a second ablation, if it is needed at all, will be much quicker and with much less ablation work being required.
DennisC just finished his touch-up last week and remarked to me several times in the days immediately afterward how really good he felt and that the NSR was great. And Dennis has really had a big challenge with having had open heart surgery just this last December to have his whole upper aorta replaced and re-plumbed! He felt so good that he and his wife diverted their planned direct return to NYC from Austin 3 days after his ablation, in order to go visit relatives in Orlando for some days of R&R where they are still now I believe.
So Smackman, don't fret over how long you have had persistent AFIB, it is what it is now and you've got the very best guy possible to make the very best of the situation. You really can't ask for anything better than that ...
Best wishes and keep us posted how it all is going from Austin, we'll all be sending good thoughts your way on Feb 27!
Cheers!
Shannon
LOL